Nursing 7208 Adult Gerontology Acute Care Nurse Practicum Q&A, Exams of Nursing

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NURSING 7208

Adult Gerontology

Acute Care Nurse

Practitioner Practicum

Q & A w/ Rationales

1. When assessing a patient during the Adult-Gerontology Acute Care Nurse Practitioner (AG-ACNP) practicum, the presence of a widened mediastinum on chest X-ray is suggestive of which condition? a) Acute myocardial infarction b) Pulmonary embolism c) Aortic dissection d) Pleural effusion Correct answer: c) Aortic dissection Rationale: A widened mediastinum on chest X-ray is often seen in patients with aortic dissection, which is a life- threatening condition. It is important for the AG-ACNP to recognize this finding and initiate appropriate interventions promptly.
2. During the AG-ACNP practicum, a patient presents with sudden onset of severe chest pain, dyspnea, and tachypnea. The nurse practitioner suspects a pulmonary embolism. Which diagnostic test is considered the gold standard for confirming this diagnosis? a) Chest X-ray b) Magnetic resonance imaging (MRI) c) Spiral computed tomography (CT) scan d) Pulmonary angiography Correct answer: d) Pulmonary angiography Rationale: Pulmonary angiography is considered the gold standard diagnostic test for confirming a pulmonary

d) Azithromycin Correct answer: c) Vancomycin Rationale: Vancomycin is the drug of choice for treating MRSA infections. It has excellent activity against this antibiotic-resistant pathogen and is commonly utilized in septic patients.

5. A patient with heart failure exacerbation is prescribed furosemide (Lasix) to improve diuresis. The nurse practitioner anticipates monitoring for which electrolyte imbalance associated with the use of this medication? a) Hypernatremia b) Hypokalemia c) Hypercalcemia d) Hypermagnesemia Correct answer: b) Hypokalemia Rationale: Furosemide (Lasix) is a loop diuretic that promotes the excretion of sodium and water. Along with sodium, potassium is also excreted, leading to the potential development of hypokalemia. AG-ACNPs should closely monitor potassium levels and intervene as needed to prevent cardiac complications.
6. During an AG-ACNP practicum, a patient presents with sudden vision loss and severe eye pain. The nurse practitioner suspects acute angle-closure glaucoma. Which intervention should be the nurse practitioner's priority? a) Administering topical corticosteroids

b) Applying warm compresses to the affected eye c) Instilling dilating drops into the affected eye d) Initiating immediate referral to an ophthalmologist Correct answer: d) Initiating immediate referral to an ophthalmologist Rationale: Acute angle-closure glaucoma is a medical emergency that requires immediate evaluation and management by an ophthalmologist. Prompt referral ensures appropriate treatment and prevents permanent vision loss.

7. A patient with acute kidney injury (AKI) requires initiation of renal replacement therapy (RRT). Which form of RRT provides continuous, gentle fluid removal and solute clearance, making it suitable for hemodynamically unstable patients? a) Hemodialysis b) Continuous venovenous hemofiltration (CVVH) c) Peritoneal dialysis d) Continuous renal replacement therapy (CRRT) Correct answer: d) Continuous renal replacement therapy (CRRT) Rationale: CRRT, specifically CVVH, is a form of renal replacement therapy that provides continuous, slow fluid removal and solute clearance. It is preferred for hemodynamically unstable patients as it allows for gradual shifts in fluid and electrolyte balance.

exacerbations of COPD. It works by relaxing the smooth muscles of the airways, improving airflow and relieving symptoms such as dyspnea and wheezing.

10. In an AG-ACNP practicum, a patient with a suspected deep vein thrombosis (DVT) is scheduled for a duplex ultrasound. The student nurse practitioner examines the patient's leg for signs and symptoms of DVT, which include: a) Pallor and decreased capillary refill b) Increased warmth and erythema c) Bradycardia and hypotension d) Cyanosis and pitting edema Correct answer: b) Increased warmth and erythema Rationale: Signs and symptoms of DVT include increased warmth and erythema in the affected extremity, often accompanied by swelling and tenderness. These findings indicate potential thrombus formation in the deep veins.
11. During an AG-ACNP practicum, a patient diagnosed with pneumonia is admitted to the hospital. Which antibiotic agent is most commonly used as the initial empiric treatment for community-acquired pneumonia? a) Ceftriaxone b) Azithromycin c) Vancomycin d) Linezolid Correct answer: b) Azithromycin

Rationale: Azithromycin is one of the recommended first- line agents for treating community-acquired pneumonia in non-severe cases. It covers common pathogens such as Streptococcus pneumoniae and Haemophilus influenzae.

12. A patient with a known allergy to cephalosporins is prescribed antibiotics for a suspected urinary tract infection. The nurse practitioner selects an alternative antibiotic from the beta-lactam class, which is considered safe for patients with cephalosporin allergy. Which antibiotic is suitable in this situation? a) Ciprofloxacin b) Vancomycin c) Azithromycin d) Penicillin Correct answer: d) Penicillin Rationale: Patients with cephalosporin allergy can often tolerate penicillins, as these antibiotics have a different chemical structure. Therefore, penicillin can serve as a safe alternative for patients with cephalosporin allergy.
13. A patient with congestive heart failure (CHF) requires initiation of medication to reduce preload and afterload, and improve cardiac function. Which medication class would be most appropriate to prescribe? a) Angiotensin-converting enzyme (ACE) inhibitors b) Calcium channel blockers c) Beta-blockers d) Diuretics

a) Rebound tenderness b) Deep palpation c) Psoas sign d) McBurney's point tenderness Correct answer: d) McBurney's point tenderness Rationale: McBurney's point tenderness, located in the right lower quadrant, is a classic sign of acute appendicitis. It occurs due to inflammation and irritation of the appendix in this region. Assessing for this tenderness is a significant part of diagnosing this condition. B: Question: During the assessment of an elderly patient with acute respiratory distress, which of the following findings should the nurse prioritize? A) Hypotension B) Decreased breath sounds on the right lower lobe C) Elevated temperature D) Decreased urine output Answer: B) Decreased breath sounds on the right lower lobe Rationale: In a patient with acute respiratory distress, decreased breath sounds on a specific area of the lung indicate potential lung pathology and require immediate attention to ensure adequate oxygenation.

Question: When managing a critically ill older adult with septic shock, the nurse should prioritize which intervention? A) Administering antipyretics to reduce fever B) Initiating broad-spectrum antibiotics C) Monitoring blood glucose levels D) Administering low-dose dopamine to improve renal perfusion Answer: B) Initiating broad-spectrum antibiotics Rationale: In septic shock, the timely administration of broad-spectrum antibiotics is crucial to target the underlying infection and improve patient outcomes. Question: A patient with acute exacerbation of chronic heart failure presents with jugular venous distention and bilateral crackles in the lungs. What intervention should the nurse prioritize? A) Administering a loop diuretic B) Initiating non-invasive positive pressure ventilation C) Administering inotropic support D) Placing the patient in a high-Fowler's position Answer: B) Initiating non-invasive positive pressure ventilation Rationale: In the presence of jugular venous distention and bilateral crackles, non-invasive positive pressure ventilation can help improve oxygenation and reduce the work of breathing in patients with acute decompensated heart failure.

A) Administering nephrotoxic antibiotics B) Maintaining euvolemia C) Allowing for prolonged periods of hypotension D) Administering high-dose loop diuretics Answer: B) Maintaining euvolemia Rationale: Maintaining euvolemia through appropriate fluid management is crucial in preventing further renal damage and promoting renal perfusion in patients with acute kidney injury. Question: In a patient with acute gastrointestinal bleeding, which finding should the nurse prioritize during the initial assessment? A) Tachycardia and hypotension B) Elevated temperature C) Increased bowel sounds D) Hypertension and bradycardia Answer: A) Tachycardia and hypotension Rationale: Tachycardia and hypotension are indicative of hypovolemic shock in the setting of acute gastrointestinal bleeding, requiring immediate intervention to stabilize the patient's hemodynamic status. Question: When managing a patient with acute exacerbation of chronic obstructive pulmonary disease (COPD), which intervention should the nurse prioritize to improve oxygenation? A) Administering high-flow oxygen via nasal cannula B) Initiating nebulized bronchodilators C) Placing the patient in a supine position

D) Administering intravenous corticosteroids Answer: A) Administering high-flow oxygen via nasal cannula Rationale: Administering high-flow oxygen via nasal cannula can help improve oxygenation and reduce the work of breathing in patients with acute exacerbation of COPD. Question: A patient with acute chest pain is suspected of having acute coronary syndrome. Which diagnostic test should the nurse prioritize to confirm the diagnosis? A) Electrocardiogram (ECG) B) Cardiac catheterization C) Troponin levels D) Stress test Answer: A) Electrocardiogram (ECG) Rationale: An ECG is the initial diagnostic test of choice to assess for ST-segment changes indicative of acute coronary syndrome and guide further management. Question: In a patient with acute intracranial hemorrhage, which intervention should the nurse prioritize to prevent secondary brain injury? A) Administering hypertonic saline B) Maintaining normothermia C) Allowing for hypotension D) Elevating the head of the bed to 90 degrees Answer: B) Maintaining normothermia Rationale: Maintaining normothermia is essential in preventing secondary brain injury and optimizing outcomes in patients with acute intracranial hemorrhage.

B) Elevating the head of the bed C) Administering mannitol D) Initiating seizure precautions Answer: D) Initiating seizure precautions Rationale: Decerebrate posturing is indicative of severe neurological compromise, and initiating seizure precautions is essential to prevent further injury and promote patient safety. Question: In a patient with acute exacerbation of acute respiratory distress syndrome (ARDS), which intervention should the nurse prioritize to improve oxygenation? A) Proning the patient B) Administering diuretics C) Initiating continuous renal replacement therapy D) Administering sedatives Answer: A) Proning the patient Rationale: Proning the patient is a crucial intervention in improving oxygenation and optimizing ventilation- perfusion matching in patients with acute exacerbation of ARDS. Question: A patient with acute myocardial infarction is scheduled for percutaneous coronary intervention (PCI). What information should the nurse prioritize in the pre- procedure assessment? A) Allergy to iodine-based contrast dye B) History of diabetes mellitus C) Current medication list D) Family history of cardiovascular disease

Answer: A) Allergy to iodine-based contrast dye Rationale: Assessing for allergies to iodine-based contrast dye is crucial in the pre-procedure assessment of a patient scheduled for PCI to prevent potential adverse reactions during the intervention. C:

1. A 65-year-old patient with a history of chronic obstructive pulmonary disease (COPD) and hypertension is admitted to the intensive care unit (ICU) with acute respiratory failure and sepsis. The patient is intubated and mechanically ventilated. The adult-gerontology acute care nurse practitioner (AGACNP) orders arterial blood gas (ABG) analysis, which shows pH 7.25, PaCO2 55 mmHg, PaO2 60 mmHg, HCO3 24 mEq/L, and SaO2 90%. Based on these results, the AGACNP interprets that the patient has: A) Acute respiratory acidosis with partial compensation B) Acute respiratory alkalosis with partial compensation C) Chronic respiratory acidosis with partial compensation D) Chronic respiratory alkalosis with partial compensation *Answer: A) Acute respiratory acidosis with partial compensation Rationale: Respiratory acidosis occurs when there is an increase in PaCO2 due to hypoventilation. Acute respiratory acidosis is characterized by a pH below 7.

arrhythmias, muscle weakness, and metabolic alkalosis. Therefore, it is important to monitor the potassium level in patients receiving IV furosemide, especially those with cardiac and renal problems. Blood glucose, blood pressure, and creatinine levels are also important to monitor, but potassium level is the most critical parameter in this scenario.

3. A 55-year-old patient with a history of asthma and allergic rhinitis is admitted to the ICU with anaphylactic shock after being stung by a bee. The patient has urticaria, angioedema, hypotension, tachycardia, and wheezes. The AGACNP initiates IV fluid resuscitation and administers epinephrine (Adrenalin), diphenhydramine (Benadryl), and methylprednisolone (Solu-Medrol). What is the mechanism of action of epinephrine in anaphylactic shock? A) It blocks histamine receptors and reduces inflammation B) It inhibits mast cell degranulation and prevents further release of mediators C) It stimulates alpha-1, beta-1, and beta-2 receptors and reverses vasodilation and bronchoconstriction D) It suppresses the immune system and prevents antibody production *Answer: C) It stimulates alpha-1, beta-1, and beta- 2 receptors and reverses vasodilation and bronchoconstriction Rationale: Epinephrine is the first-line treatment for anaphylactic shock because it has multiple effects that counteract the life-threatening manifestations of anaphylaxis. Epinephrine stimulates alpha-1 receptors in

the blood vessels, causing vasoconstriction and increasing blood pressure. It also stimulates beta-1 receptors in the heart, increasing heart rate and contractility. Additionally, it stimulates beta-2 receptors in the lungs, causing bronchodilation and improving airflow. Epinephrine does not block histamine receptors, inhibit mast cell degranulation, or suppress the immune system. These are the actions of antihistamines, mast cell stabilizers, and corticosteroids, respectively.

4. A 45-year-old patient with a history of hypertension and smoking is admitted to the ICU with acute ischemic stroke. The patient has left-sided hemiparesis, aphasia, and dysphagia. The AGACNP orders a computed tomography (CT) scan of the head, which confirms the diagnosis of ischemic stroke. The AGACNP decides to administer alteplase (Activase), a recombinant tissue plasminogen activator (tPA), to dissolve the clot and restore blood flow to the brain. What is the time window for administering alteplase in ischemic stroke? A) Within 3 hours of symptom onset B) Within 4.5 hours of symptom onset C) Within 6 hours of symptom onset D) Within 12 hours of symptom onset *Answer: B) Within 4.5 hours of symptom onset Rationale: Alteplase is a thrombolytic agent that converts plasminogen to plasmin, which breaks down fibrin and dissolves clots. Alteplase can improve the outcome of ischemic stroke by reducing the infarct size and preserving the neurological function. However, alteplase also